Background:Post-operative course after complex pediatric cardiac surgery is unpredictable. Although, change in arterial lactate levels has been used as a surrogate marker for many years, scientific evidence correlating the early perioperative lactate levels with outcome is still lacking.Objective:To evaluate the trends in lactate levels from intraoperative period to an extended post-operative period in pediatric intensive care unit (PICU) and to assess its usefulness as a prognostic marker.Design:Prospective observational study.Setting:Tertiary pediatric cardiac surgical unit.Patients:Thirty-five non-consecutive children aged 1-140 months who underwent surgery for congenital heart diseases (CHD) on cardiopulmonary bypass (CPB).Intervention:None.Materials and Methods:Arterial blood lactate levels were obtained at the following time points: After induction of anesthesia, 15 and 45 min after institution of CPB, at the start of rewarming, after sternotomy closure, then at 1, 6, 24, and 48 h in PICU. Other hemodynamic and clinical variables, CPB variables, blood gas values, and laboratory variables were also recorded.Results:Four patients died out of 35 patients (11.4%). Non-survivors showed significant persistent elevation in lactates (>4.0 mmol/l). Peak lactates correlate significantly with longer aortic cross clamp time, CPB duration, ventilation hours and PICU stay.Conclusion:Early point of care lactate can be a useful prognostic marker in post-cardiac surgery patients in adjunct with other parameters measured in PICU. This reiterates the importance of measuring lactates and timely recognition of at-risk patients, which on early intervention can help in reducing post-operative morbidity and mortality.

Coronaviruses are a family of viruses affecting human beings through animal transmission causing viral pneumonia leading to severe acute respiratory syndrome. In this article, we analysed the effect of the COVID-19 pandemic on the orthopaedic practice and its repercussions on patient care. In this article we tried to highlight the challenges faced by the healthcare professionals in the wake of coronavirus pandemic, difficulties in patient care and the possible solutions while helping combating the pandemic.

<p class="abstract">Floating knee injuries are commonly seen nowadays due to increase in road traffic accidents. However, bilateral presentation of floating knee is a rare injury and challenging to orthopaedicians for a good functional outcome. We hereby present a rare case of bilateral floating knee injury in a 45 year old male treated with open reduction and internal fixation in a staged procedure. Functional assessment was done using modified Karlstrom-Olerud criteria which showed excellent outcome. Union was achieved in approximately 7 months. Decreased knee movements over left side as compared to right side was only complication seen.</p>

<p>Necrotizing fasciitis caused by <em>Pseudomonas aeruginosa</em> is an extremely rare and life threatening bacterial soft tissue infection. Here we report a case study of fully established necrotizing fasciitis associated with monomicrobial pseudomonas infection in a 34 years old male. The patient presented with painful, necrosed areas of skin and soft tissue over right gluteal region which rapidly progressed to right upper back. Aggressive supportive measures and early debridement lead to a full recovery with no functional deficits.</p>

<p>Injuries around the hip joint are one of the most common orthopedic injuries and these types of injuries are grossly debilitating until treated properly. Simultaneous occurrence of fracture of proximal femur with fracture of ipsilateral acetabulum or pelvis is termed as floating hip injury. These injuries are very rare, only to be found 1 in 10,000 as well as there is lack of literature support regarding proper treatment protocol. Here we are going to present a case of fracture of neck of left femur along with fracture of left acetabulum in a 45 years old male undergone road traffic accident.</p><p> </p>